payments.hsrgc.gr Open in urlscan Pro
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1 forms found in the DOM

POST /payments.php

<form method="POST" action="/payments.php" id="billing_form">
  <input type="hidden" name="_nonce" value="b9d2942e8de1fe96690ae3edb7e315ea">
  <h1>Billing information</h1>
  <table>
    <tbody>
      <tr>
        <th>
          <label for="field_surname">Last name</label>
        </th>
        <td>
          <input type="text" name="fields[surname]" id="field_surname" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_name">First name</label>
        </th>
        <td>
          <input type="text" name="fields[name]" id="field_name" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_email">E-mail</label>
        </th>
        <td>
          <input type="email" name="fields[email]" id="field_email" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_email_confirm">Confirm E-mail</label>
        </th>
        <td>
          <input type="email" name="fields[email_confirm]" id="field_email_confirm" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_phone">Phone number</label>
        </th>
        <td>
          <input type="text" name="fields[phone]" id="field_phone" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_address">Address</label>
        </th>
        <td>
          <input type="text" name="fields[address]" id="field_address" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_city">City</label>
        </th>
        <td>
          <input type="text" name="fields[city]" id="field_city" required="">
        </td>
      </tr>
      <tr>
        <th>
          <label for="field_postcode">Postal code</label>
        </th>
        <td>
          <input type="text" name="fields[postcode]" id="field_postcode" required="">
        </td>
      </tr>
      <tr>
        <th><label for="field_country">Country</label></th>
        <td>
          <select name="fields[country]" id="field_country" required="" data-select2-id="field_country" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
            <option disabled="" selected="" value="" data-select2-id="2">Select:</option>
            <option value="300">Greece</option>
            <option value="276">Germany</option>
            <option value="250">France</option>
            <option value="380">Italy</option>
            <option value="756">Switzerland</option>
            <option value="840">USA</option>
            <option value="826">UK</option>
            <option value="784">United Arab Emirates</option>
            <option value="0">Other</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="1" style="width: 149px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-field_country-container"><span class="select2-selection__rendered" id="select2-field_country-container" role="textbox"
                  aria-readonly="true" title="Select:">Select:</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
        </td>
      </tr>
    </tbody>
  </table>
  <h1>Payment information</h1>
  <table>
    <tbody>
      <tr>
        <th><label for="field_reason">Reason of payment</label></th>
        <td>
          <select name="fields[reason]" id="field_reason">
            <option selected="" value="">Custom amount due</option>
            <option value="1" data-amount="15">Membership fees for 1 year (15 EUR)</option>
            <option value="2" data-amount="30">Membership fees for 2 years (30 EUR)</option>
          </select>
          <!--br/-->
        </td>
      </tr>
      <tr>
        <th><label for="field_amount">Amount</label></th>
        <td>
          <input type="number" min="1.00" step="0.01" name="fields[amount]" id="field_amount" placeholder="0.00" required="" style="width:6rem;padding-right:0;text-align:center;">&nbsp;<strong>EUR</strong>
          <!--input type="number" name="fields[amount]" id="field_amount" required
                                min="1" /-->
        </td>
      </tr>
      <tr>
        <th><label for="field_notes">Comments</label></th>
        <td><textarea name="fields[notes]" id="field_notes" placeholder="eg. the reason associated with your payment, or any other remarks"></textarea></td>
      </tr>
    </tbody>
  </table>
  <div class="form_footer">
    <label>
      <input type="checkbox" name="accept_terms" id="field_terms" required="" autocomplete="off"> I agree to the <a href="/payment_terms.php" target="_blank">terms and conditions</a>
    </label>
    <br>
    <div class="form_buttons">
      <input type="submit" name="hsrgc_submit" value="Continue">
      <input type="reset" value="Reset">
    </div>
  </div>
</form>

Text Content

HELLENIC SOCIETY ON RELATIVITY, GRAVITATION AND COSMOLOGY



 * HSRGC Members
 * Related Organizations
 * Useful Links
 * Public Outreach
 * Contact
 * Privacy Policy & Terms of Use


HSRGC NEWS

Forthcoming Greek Events

Please send us your comments or/and questions.

We will be happy to communicate with you!


DISCUSSION FORUM

Under construction...

 * Home
 * History
 * Organization
 * Activities
 * Membership & Dues


PAYMENTS TO THE HELLENIC SOCIETY ON RELATIVITY, GRAVITATION AND COSMOLOGY




Use your credit or debit card to make a payment safely using the secure
environment provided by Piraeus Bank.

 * All fields are required, except Comments. Please type your name as it appears
   on the card you will use (latin characters only).
   
   
 * Select a predefined amount or enter a custom value in euros. 2 decimals are
   allowed.
 * In case you enter a custom amount, make sure to state the reason of your
   payment in the Comments field.


BILLING INFORMATION

Last name First name E-mail Confirm E-mail Phone number Address City Postal code
Country Select: Greece Germany France Italy Switzerland USA UK United Arab
Emirates Other Select:


PAYMENT INFORMATION

Reason of payment Custom amount due Membership fees for 1 year (15
EUR)Membership fees for 2 years (30 EUR) Amount  EUR Comments

I agree to the terms and conditions






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